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SAM-e for Depression

S-adenosylmethionine or SAM-e, a natural antidepressant, has been in the news lately thanks to Dr. Andrew Weil. In Dr. Weil’s new book, Spontaneous Happiness, he recommends SAM-e for prompt relief of low mood states that don’t respond to other dietary and lifestyle modifications. A review in the June 2011 issue of the journal Canadian Family Physician also presents a largely optimistic view of this nutritional supplement. In the summary, the primary criticism of SAM-e is how much it costs. In order to reach a therapeutic dosage, the author of the piece estimates a monthly expense of $80 – an amount that likely won’t be covered by most insurance plans. In reality, savvy online shoppers can find even lower prices in the $60/month neighborhood.

The first thing you need to know about SAM-e is that it can be administered in two ways: orally or parenterally (via injection). All of the research you’ll find below is based on human studies using oral SAM-e supplements. The most common dosage used as a stand-alone treatment for patients with major depression has been 1,600 mg/day. In one study, a four week trial comparing SAM-e to a conventional antidepressant (desipramine) resulted in a 62% response rate in the SAM-e users vs. 50% in the patients given desipramine. Other trials have examined the effects of combining SAM-e with pharmaceutical antidepressants in patients who didn’t respond to the medications alone. The findings of these trials have been quite impressive. SAM-e has consistently demonstrated an ability to improve treatment response rates and reduce remission rates. The most recent study also reported an improvement in cognitive performance in depressed patients taking SAM-e as an adjunct to standard care. Other health conditions that frequently involve mood disturbance, such as fibromyalgia and Parkinson’s disease, may likewise respond to SAM-e supplementation. But, it’s important to note that the dosages employed for these conditions vary from 800 mg/day for fibromyalgia to up to 3,200 mg/day for those living with Parkinson’s disease. In terms of safety and tolerability, SAM-e trumps conventional antidepressants according to preliminary research. However, a small number of users may experience transient anxiety, gastrointestinal upset or manic episodes.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 -Complementary and Alternative Medicine for the Treatment of …(link)

I’m currently away on a business trip and have limited Internet access. So, I probably won’t be able to access the links you’ve posted until I return home. But, I did want to offer a brief reply to your thoughtful question.

From my perspective, the short answer is as follows: SAM-e differs from any of the pharmaceutical antidepressants because it naturally occurs in the body. It’s not a foreign substance such as Effexor (Venlafaxine), Prozac (Fluoxetine) or Wellbutrin (Bupropion).

As far as the cost goes, SAM-e is often more expensive than prescribed mood boosters (in the US and many other countries) because insurance plans rarely cover nutritional supplements.

Effect and Path Analysis of Laughter Therapy on Serotonin, Depression and Quality of Life in Middle-aged Women.

PURPOSE: This study was done to examine how laughter therapy impacts serotonin levels, QOL and depression in middle-aged women and to perform a path analysis for verification of the effects.

METHODS: A quasi-experimental study employing a nonequivalent control group and pre-post design was conducted. Participants were 64 middle-aged women (control=14 and experimental=50 in 3 groups according to level of depression). The intervention was conducted five times a week for a period of 2 weeks and the data analysis was conducted using repeated measures ANOVA, ANCOVA and LISREL.

RESULTS: Results showed that pre serotonin and QOL in women with severe depression were the lowest. Serotonin in the experimental groups increased after the 10th intervention (p=.006) and the rise was the highest in the group with severe depression (p=.001). Depression in all groups decreased after the 5th intervention (p=.022) and the biggest decline was observed in group with severe depression (p=.007). QOL of the moderate and severe groups increased after the 10th intervention (p=.049), and the increase rate was highest in group with severe depression (p

CONCLUSION: Results indicate that serotonin activation through laughter therapy can help middle-aged women by lessening depression and providing important grounds for depression control.

METHODS: We examined a subsample (n=144) from one site of a two-site study of adults with diagnosed Major Depressive Disorder (MDD), recruited from 4/13/05 to 12/22/09, who consented to the additional blood draw for serum histamine and carnitine levels. After washout, eligible subjects were randomized to SAMe (1600-3200mg/daily), escitalopram (10-20mg/daily), or matching placebo for 12 weeks of double-blind treatment (titration at week 6 in non-response).

RESULTS: On the primary outcome of the Hamilton Depression Rating Scale (HAMD-17), a significant difference in improvement was observed between groups from baseline to week 12 (p=0.039). The effect size from baseline to endpoint was moderate to large for SAMe versus placebo (d=0.74). SAMe was superior to placebo from week 1, and to escitalopram during weeks 2, 4, and 6. No significant effect was found between escitalopram and placebo or SAMe. Response rates (HAMD-17≥50% reduction) at endpoint were 45%, 31%, and 26% for SAMe, escitalopram, and placebo, respectively; while remission rates (HAM-D≤7) were 34% for SAMe (p=0.003), 23% for escitalopram (p=0.023), and 6% for placebo. No correlation between baseline histamine level and reduction of HAMD-17 score was found for either the SAMe or escitalopram groups. Baseline carnitine levels were also not found to moderate response to either treatment.

LIMITATIONS: While SAMe appears to be an effective antidepressant agent, the overall findings from the parent study (which showed no significant difference between groups due to site differences) must be taken into consideration.

CONCLUSIONS: These preliminary results provide encouraging evidence for the use of SAMe in the treatment of MDD. Histamine and carnitine serum level may not necessarily moderate response to SAMe.

A pilot study of S-adenosylmethionine in treatment of functional abdominal pain in children.

CONTEXT: Functional abdominal pain (FAP) is one of the most common functional gastrointestinal disorders (FGIDs) in children. Currently, medical practitioners widely use tricyclic antidepressants to treat FAP. Those antidepressants, however, have been associated with an increased risk of suicidal ideation, and the accompanying side effects often limit the benefits. S-adenosylmethionine (SAM-e) is a dietary supplement that has efficacy as an antidepressant and as a treatment for chronic pain.

OBJECTIVE: The research team hypothesized that during SAM-e exposure (1) participants’ pain reports would significantly improve over time, (2) participants’ reported quality of life would significantly improve over time, and (3) toxicity measures (liver-function tests and mania and depression scales) would not change significantly.

DESIGN: The research team performed an open-label, doseescalation trial of oral SAM-e among children with FAP. Participants came to the research facility for measurements at baseline and after 2 wk, 1 mo, and 2 mo. The research team monitored participants for potential toxicities (liver toxicity, mania, and depression) throughout the trial.

SETTING: The trial was conducted at the University of California, San Diego.

PARTICIPANTS: The research team recruited children and adolescents with FAP via advertisement at several community general pediatric clinics and at the research team’s subspecialty pediatric gastrointestinal clinic at a tertiary care center. The eight resulting participants were children with a median and mean age of 14 y.

INTERVENTION: To treat persistent abdominal pain, all participants received SAM-e at an initial dose of 200 mg/d, with escalation to a maximum dose of 1400 mg/d over the period of 2 mo.

OUTCOME MEASURES: The primary outcomes were the participants’ self-reports of pain and quality of life. The research team used the multidimensional measure for recurrent abdominal pain (MM-RAP), Wong-Baker FACES Pain Rating Scale, and the PedsQL for those measurements. The team used repeated measures analyses to analyze the data.

RESULTS: Six participants completed the study. The research team demonstrated an improvement in self-pain reports over the 2-mo follow-up period (P = .004). The median dose of SAM-e that participants took at the 2-mo follow-up period was 1400 mg (interquartile range: 950-1400 mg) daily. Liver function tests and assessments for mania and depression did not change over the study period.

CONCLUSIONS: Oral SAM-e demonstrates promise in reducing abdominal pain among children with FAP, with minimal toxicity. The research team needs to conduct larger, placebo-controlled trials to support its initial findings.

Adjuvant thiamine improved standard treatment in patients with major depressive disorder: results from a randomized, double-blind, and placebo-controlled clinical trial.

Given that antidepressants (ADs) work slowly, there is interest in means to accelerate their therapeutic effect and to reduce side effects. In this regard, thiamine (vitamin B1) is attracting growing interest. Thiamine is an essential nutrient, while thiamine deficiency leads to a broad variety of disorders including irritability and symptoms of depression. Here, we tested the hypothesis that adjuvant thiamine would reduce depression, compared to placebo. A total of 51 inpatients (mean age: 35.2 years; 53 % females) with MDD (Hamilton Depression Rating Scale score (HDRS) at baseline: >24) took part in the study. A standardized treatment with SSRI was introduced and kept at therapeutic levels throughout the study. Patients were randomly assigned either to the thiamine or the placebo condition. Experts rated (HDRS) symptoms of depression at baseline, and after 3, 6, and 12 weeks (end of the study). Between baseline and the end of the study, depression had reduced in both groups. Compared to placebo, adjuvant thiamine improved symptoms of depression after 6 week of treatment, and improvements remained fairly stable until the end of the study, though mean differences at week 12 were not statistically significant anymore. No adverse side effects were reported in either group. Results suggest that among younger patients with MDD adjuvant thiamine alleviated symptoms of depression faster compared to placebo. Importantly, improvements were observed within 6 weeks of initiation of treatment. Thus, thiamine might have the potential to counteract the time lag in the antidepressant effects of ADs.

Be well!

JP

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